Med/Surg Exam #1 With Questions & Answers
A upatient uis useen uat uthe uclinic ufor ua uroutine uphysical uexamination. uAfter uthe upatient uis
uassessed ufor uevidence uof uperipheral uvascular udisease, uthe unurse uexplains uthat uwhich uof uthe
ufollowing utests uis utypically uused uto uassist uin uthe udiagnosis?
1. uAllen's uTest
2. uAnkle ubrachial upressure uindex.
3. uCardiac uStress uTest. u
4. uEchocardiogram u- uCorrect u uAnswer u- u2. uAnkle ubrachial upressure uindex.
Rationale: uThe uankle ubrachial uindex u(ABI) uis uthe ublood upressure uratio ubetween uthe ulower ulegs
uand uthe uarms. uBlood upressure uin uthe ulegs uis unormally uhigher uthan uthe uarms, uand
uabnormalities uindicate unarrowing uof uthe uarteries. uClinical ufindings uthat umay usuggest uthe
upresence uof uPVD uincludes ua uhistory uof uangina uwith uactivity, uintermittent uclaudication, uand
uabnormal u(weak uor uabsent) upedal upulses. uThe uformula ufor uABI uis uthe usystolic ublood upressure
uof uthe uankle u(measured uat uthe udorsalis upedis uor uposterior utibial uarteries) udivided uby uthe
usystolic upressure uin uthe uarms. uIt uis umeasured uon uboth usides. uA uratio uof u1.0 uindicates
uperipheral uvascular udisease. uIncorrect: uAllen's utest uis uused uto uassess ublood usupply uto uthe
uhand.Incorrect: uCardiac ustress utests uare uused uto umeasure uthe uheart's uability uto urespond uto
ustress. uIncorrect: uECG uevaluates uthe ustructure uand ufunction uof uthe uheart umuscle, ubut udoes unot
utell uif uthere uis uperipheral uvascular udisease upresent.
A upatient uhas ubeen udiagnosed uwith uleft-sided ucongestive uheart ufailure, uand uis uconfused uabout
uthe ureturn uof uoxygenated ublood ufrom uthe ulungs. uTo uclarify uthe uconfusion, uthe unurse uexplains
uall uchambers uof uthe uheart udealing uwith ublood ucirculation. uThe unurse uis ucorrect uwhen ushe utells
uthe uclient:
1. uA umuscular uspace ucalled uthe upericardial uspace useparates uthe uchambers uof uthe uright uside
ufrom uthe uleft uside. u
2. uBlood uflows uinto uthe uleft uventricle uwhich upumps uit uout uagainst uhigh uresistance uinto uthe
usystemic ucirculation. u
3. uThe ublood umoves uto uthe uleft uventricle, uwhich upumps ublood uinto uthe ulungs. u
,3. uThe uheart uconsists uof u5 uchambers. u
4. uThe uleft uatrium ureceives uoxygenated ublood ufrom uthe ulungs. u
5. uThe uright uatrium ureceives udeoxygenated ublood ufrom uthe ubody utissues. u- uCorrect u uAnswer u-
u2. uBlood uflows uinto uthe uleft uventricle uwhich upumps uit uout uagainst uhigh uresistance uinto uthe
usystemic ucirculation. u
3. uThe ublood umoves uto uthe uleft uventricle, uwhich upumps ublood uinto uthe ulungs. u
4. uThe uleft uatrium ureceives uoxygenated ublood ufrom uthe ulungs. u
5. uThe uright uatrium ureceives udeoxygenated ublood ufrom uthe ubody utissues. u
Rationale: uHeart uconsists uof u4 uchambers: u2 uatria uand u2 uventricles. uThe uright uand uleft uchambers
uare useparated udown uthe umiddle uof uthe uheart uby ua useptum, ulike ua uwall. uThe uright uatrium
ureceives udeoxygenated ufrom uthe ubody, uand uthe ublood uthen umoves udown uinto uthe uright
uventricle, uwhich upumps uit uto uthe ulungs uwith ulow uresistance. uThe uleft uatrium uthen ureceives
uoxygenated ublood ufrom uthe ulungs, uand uthat ublood umoves udown uinto uthe uleft uventricle. uThe
uleft uventricle, uwhich uis uthe umost umuscular uchamber, upumps uoxygen urich ublood uinto uthe
usystemic ucirculation.
A upatient urecovering ufrom ua uMI uhas ubeen uin ubed ufor u6 udays. uThe upatient unow ucomplains uof
ucalf upain. uThe unurse ushould ufirst: u
1. uAdminister upain umedication uas uordered. u
2. uAssess uthe ucalf ufor uredness uwarmth uand uswelling. u
3. uMassage uthe ucalf uto urelieve uthe umuscle ucramp. u
Observe uthe upatient uwalking. u- uCorrect u uAnswer u- u2. uAssess uthe ucalf ufor uredness uwarmth uand
uswelling. u
Rationale: uDue uto uthe utime uspend uin ubed uand uinactive, uthe upatient uis uat uhigh urisk ufor uthe
udevelopment uof ua uDVT. uPain uin uthe ucalf, uredness uor uheat, uand uswelling uin uthe uaffected
uextremity uare usigns uof ua uDVT. uDiagnostic utests uthat uhelp udiagnose ua uDVT uinclude ua uD-dimer
utest uto uconfirm uthe upresence uof ufibrin udegradation uin uproducts ufrom ua uclot, uvenous
uultrasound, uvenography uto uvisualize uthe uclot uwith ucontrast, uor uless ucommonly uMRI uor uCT.
The unurse uis ucaring ufor ua upatient uin uthe uearly ustages uof uheart ufailure. uThe ufamily uis ucurious uas
uto uhow uthe ubody uadapts uto uheart ufailure. uThe unurse uknows uthat uduring uthe uearly ustages uof
uheart ufailure, uwhich uspecific ucompensatory umechanisms uoccur? u
,1. uDecreased ucardiac uoutput uinhibits uthe urelease uof uADH uby uthe upituitary ugland.
2. uHypotension ustimulates uthe ubaroreceptors uto uincrease usympathetic uactivity. u
3. uHypotension ustimulates uthe ubaroreceptors uto udecrease usympathetic uactivity. u
4. uImpaired urenal uperfusion uinhibits ualdosterone urelease. u- uCorrect u uAnswer u- u2. uHypotension
ustimulates uthe ubaroreceptors uto uincrease usympathetic uactivity. u
Rationale: uAs uarterial ublood upressure ufalls, uthe ubaroreceptors uof uthe ucarotid uand uaorta uare
ustimulated. uThis ucauses ua usympathetic urelease uof ucatecholamines, uresulting uin uvasoconstriction
uand uan uincreased uheart urate uto ucompensate. uThe ucompensatory umechanism uincreases
uperipheral uvascular uresistance uand ualso uthe uwork uload uof uthe uheart. uThis ucan uworsen uheart
ufailure uif unot utreated. u
Incorrect: uDecreased ucardiac uoutput uwill uINCREASE uADH urelease, uleading uto ufluid uretention. u
Incorrect: uImpaired urenal uperfusion uwill ustimulate ualdosterone urelease uleading uto uaddition ufluid
uand usodium uretention.
The unurse uis uassessing ua upatient uwith uatrial ufibrillation uand ua urapid uventricular urate. uThe unurse
uwould uexpect uto usee:
1. uDistended ujuglar uveins. u
2. uDizziness uand uhypotension. u
3. uHypertension uand uheadache. u
4. uLower uextremity upain. u- uCorrect u uAnswer u- u2. uDizziness uand uhypotension. u
Rationale: uAtrial ufibrillation uis uany uarrhythmia uin uwhich uthe uatria uinitiate urapid, uineffective
ucontractions uthat uare unot usynchronized uwith uventricular ucontractions. uThis upatient uhas
uuncontrolled uatrial ufibrillation, uwhich ucan uresult uin ua ulow ucardiac uoutput. uSigns uand usymptoms
uof ua ulow ucardiac uoutput uinclude uhypotension, udizziness, uweakness, ufatigue, ushortness uof ubreath,
uand usyncope.
The unurse uis ucaring ufor ua upatient uscheduled uto uundergo ua umitral uvalve ureplacement. uThe unurse
ushould umonitor ufor uwhich ucomplication uof umitral ustenosis?
1. uLeft-sided uheart ufailure. u
2. uMI
, 3. uPulmonary uHypertension u
4. uRespiratory uAlkalosis u- uCorrect u uAnswer u- u3. uPulmonary uHypertension u
Rationale: uMitral ustenosis uimpeded ublood uflow ufrom uthe uleft uatrium uto uthe uleft uventricle uof uthe
uheart. uThis ucreates uincreased upulmonary uvascular uresistance, ucausing upulmonary uhypertension.
uOther ucomplications uof umitral ustenosis uinclude uedema, uright-sided uheart ufailure, uand ureduced
ucardiac uoutput.
A unurse uis uassessing ua upatient uwho uhas ulongstanding uhypertension. uThe unurse uknow uthat
ucomplications uof uhypertension uare upossibly uarising uwhen uwhich uof uthe ufollowing usigns uare
unoted?
1. uDyspnea uduring uactivity
2. uFatigability u
3. uRecurrent uepisodes uof usevere uheadache. u
4. uTrace uproteins uin uthe uurinalysis. u- uCorrect u uAnswer u- u4. uTrace uproteins uin uthe uurinalysis. u
Proteinuria uand ualbuminuria uare uearly uindications uof urenal uinjury, ua userious ucomplication uthat
ucan ube ucaused uby uhypertension. uHigh upressures udamage uthe ukidney's uability uto ufilter utoxins,
uand uevidence uof uthis udamage uis useen uas uproteins uleak uout uof uthe uurine. uThe uother uchoices
uare unot udirect uindicators uof uprogressive udisease uor ucomplications. uFatigability uand uheadache
uare usymptoms uof uhypertension ubut uare unot udirect uindicators uof uprogressive udisease uor
ucomplications. uThese umay ube uside ueffects uof ucertain umedications uused uto utreat uhypertension.
uDyspnea uduring uactivity uis uNOT uassociated uwith uhypertension. uDyspnea ucan ube ua usign uof ulow
ucardiac uoutput u(congestive uheart ufailure), upulmonary uedema, usevere uanemia, uor ua urespiratory
uproblem u(asthma, upneumonia, uetc.). u;./
The unurse uis uevaluating ua u52 uyear uold umale ufor urisk ufactors ufor uCAD. uThe upatient uis
uoverweight, umale, uand usmokes ua upack ua uday. uThe unurse uquestions uthe upatient uabout uother
urisk ufactors uincluding:
1) uA uhistory uof uatherosclerotic uheart udisease. u
2) uA uhistory uof udiabetes. u
3) uA uhistory uof ugout. u
4) uElevated uHDL ulevels. u- uCorrect u uAnswer u- u2) uA uhistory uof udiabetes.
